Are you a bodybuilder or weightlifter or know someone who is? Snoring and obstructive sleep apnea (OSA) are common disorders, and as bodybuilders bulk up, the risks of snoring and OSA increase.

We know that there is very little information on the topic and we would like to help provide educational material.

As part of the background for this blogpost, we searched the scientific literature for information and the internet for frequently asked questions and answered them.

The goal of the blog post is to educate you on what snoring and obstructive sleep apnea are and what their relationship is with bodybuilding.

This blogpost provides illustrations that show the anatomy behind snoring and OSA and how they can be treated.

Bodybuilder airway when cut and during offseason. Note that the airway is significantly narrowed after he gained the weight. CamachoMD.com
Bodybuilder airway when cut and during offseason. Note that the airway is significantly narrowed after he gained the weight.

Disclaimer: This is a blog site that is meant for educational purposes only.  There is no affiliation with any organization. Although we do our best to provide accurate and true information, it is possible that there may be mistakes or errors. The information is not meant to provide specific medical advice and if you rely on any information on this website, it is at your own risk. Even though the writer(s) on this blog site is/are healthcare provider(s), the information is for educational purposes only. If you are a patient, then you need to consult your own healthcare provider for information that is specific to you. You may need to seek urgent or emergent care depending on your situation. You should not perform any of the procedures unless you are trained and are licensed to do them. We reserve the right to update, change, delete and manage the content at any point. Our cookie policy can be found in our privacy policy.

Summary for bodybuilding, snoring and obstructive sleep apnea:

A major goal in bodybuilding is to increase mass in order to build muscle throughout the body.

If you use the calculations for body mass index (which is the weight in kilograms divided by the height in meters squared), then a significant number of bodybuilders are technically overweight or obese, despite having a low body fat percentage.

A bodybuilder’s higher body mass index could potentially increase his or her risk of sleep-disordered breathing.

It is known that sleep-disordered breathing (snoring, upper airway resistance syndrome and obstructive sleep apnea (OSA)) is more prevalent in overweight or obese patients.

Sleep-disordered breathing research thus far has included data for ideal body weight and body mass index (BMI).

However, there has not been a sub-stratification of data for bodybuilders, who are generally fit and have a lower body fat percentage.

This blogpost helps provide background information for snoring and obstructive sleep apnea as they relate to bodybuilders.

Why are bodybuilders at high risk for snoring and obstructive sleep apnea?

Snoring and obstructive sleep apnea are due to tissues in the throat that can close off the airway.

Upper airway obstruction at the level of the soft palate. Note that since the airflow is blocked, the oxygen cannot get into the airway and carbon dioxide cannot leave. The light blue arrow points to the obstructed palate. CamachoMD.com
Upper airway obstruction at the level of the soft palate. Note that since the airflow is blocked, the oxygen cannot get into the airway and carbon dioxide cannot leave. The light blue arrow points to the obstructed palate.

Snoring is due to the vibrations of the soft tissues in the upper airway that include the soft palate and uvula generally speaking.

Once patients have obstructive sleep apnea, the airway is not only vibrating but also is closing off to the point that the flow of air becomes obstructed.

Partial obstruction of the airway can present in the form of flow limitation with arousals from sleep (respiratory effort-related arousals are scored in part due to flow limitation).

Hypopneas are when the airflow is reduced and the oxygen drops.

Apneas are when the airway is obstructed 90% or more for at least 10 seconds.[1]

Upper airway obstruction at the level of the soft palate and the tongue. Note that since the airflow is blocked, the oxygen cannot get into the airway and carbon dioxide cannot leave. The light blue arrow points to the obstructed palate and the obstructed tongue. CamachoMD.com
Upper airway obstruction at the level of the soft palate and the tongue. Note that since the airflow is blocked, the oxygen cannot get into the airway and carbon dioxide cannot leave. The light blue arrow points to the obstructed palate and the obstructed tongue.

How common are snoring and obstructive sleep apnea in bodybuilders?

Unfortunately, nobody knows how common snoring and OSA are in bodybuilders since it hasn’t been studied.

Information about bodybuilding and snoring and obstructive sleep apnea is very sparse in the medical literature.

A search on PubMed/MEDLINE for bodybuilders and snoring or OSA (search strategy: ((bodybuild*) AND (snor* OR apnea OR apnoea)) yields no article.

In fact, the only article that could be identified that was somewhat relevant is an article in the Journal of Obesity, in which the authors explored the association between sleep habits and metabolically healthy obesity (MHO) in adults. [2]

In the manuscript, the authors found that: “regularly reporting waking up during the night (i.e., 16–30 times a month), feeling unrested during the day, feeling overly sleepy during the day, and trouble falling asleep were moderately associated with the MHO phenotype.” [2]

These findings1 are consistent with signs and symptoms that are seen in upper airway resistance syndrome and OSA, therefore the obesity in these metabolically healthy adults could be causing a narrowing of the upper airway and thereby could lead to sleep-disordered breathing.

The lack of any PubMed/MEDLINE manuscript discussing findings for sleep-disordered breathing in bodybuilders is interesting, especially given that a simple search on google for bodybuilding in combination with “sleep apnea” yielded 481,000 hits and a search for bodybuilding in combination with snoring yields 557,000 hits.

Therefore, there is at minimum a large interest and/or a lot of discussion in the general population on the topic even though the medical literature has minimal information.

Are there examples of bodybuilders or powerlifters who have obstructive sleep apnea?

Forums and blogs can be easily found throughout the internet describing bodybuilders who have developed sleep-disordered breathing after they started to gain weight.

There is very little on the internet. The very few articles on the topic describe patients who died (which is rare, but can happen).

A bodybuilding.com blog post on bodybuilding and obstructive sleep apnea has pointed out the fact that being large can predispose people to an early death. They describe the case of Mike Jenkins, who was 6 feet 6 inches tall and weighed nearly 400 lbs. and had a fatal heart attack at the age of 31.

How does a bodybuilder know if they have snoring or obstructive sleep apnea?

The signs and symptoms of obstructive sleep apnea include:

  • Snoring,
  • Sleepiness,
  • Fatigue/tiredness,
  • Morning headaches,
  • Foggy brain (neurocognitive deficits),
  • Unrefreshing sleep,
  • Witnessed pauses during breathing,
  • Waking up gasping or choking at night,
  • Feeling like you are drowning and awakening in a state of panic,
  • Waking up frequently at night after falling asleep,
  • Having to wake up at night to urinate, and
  • High blood pressure without a clear cause.

Why do big necks and higher body mass indices (BMI) cause or worsen snoring and obstructive sleep apnea in bodybuilders?

The development of snoring and obstructive sleep apnea in bodybuilders happens for multiple reasons. Given that many bodybuilders have a large neck, this is an additional factor towards developing sleep-disordered breathing.

A recent systematic review evaluating neck circumference in OSA patients versus controls found that the OSA patients had a larger neck circumference by 1.26 millimeters (p-value = 0.001).[3]

It is possible that the extra tissue mass and weight in the anterior and lateral neck could displace the soft palate, uvula, and tongue backward toward the back wall of the throat and this narrows the upper airway and at least partially contributes to upper airway obstruction during sleep.

Bodybuilder snoring with his mouth open CamachoMD.com
Bodybuilder snoring with his mouth open.

Additionally, as weight gains occur, mass increases throughout the body and the tissues of the upper airway also can enlarge or hypertrophy, which thereby can narrow the upper airway during wakefulness and sleep.

Bodybuilder at competition weight, lean with an increase in airway space compared to the offseason. CamachoMD.com
Bodybuilder at competition weight, lean with an increase in airway space compared to the offseason.
Bodybuilder in the offseason. He has gained a significant amount of weight. CamachoMD.com
Bodybuilder in the offseason. He has gained a significant amount of weight.
Narrowed airway in a bodybuilder in the offseason. Note that the airway is smaller because the tongue has enlarged and the size of the airway is smaller.
Narrowed airway in a bodybuilder in the offseason. Note that the airway is smaller because the tongue has enlarged and the size of the airway is smaller.

A prospective study with overall and individual patient data stratification of bodybuilders along with their associated body measurements (i.e. BMI, body fat percentage, neck circumference, facial cephalometrics, waist measurement) and their sleep study data (percent time snoring, apnea-hypopnea index, oxygen saturation, etc.) would help determine the risk and prevalence of sleep-disordered breathing in bodybuilders.

Derek, from moreplatesmoredates.com, has an interesting perspective on sleep apnea, describing it as a silent killer.

The concept of “silent” is true, in that when there is apnea, there is silence during the event because the airway is being obstructed and there is little to no airflow and this is indeed silent.

However, it needs to be emphasized that although it is possible for someone to die from obstructive sleep apnea, it is not a common occurrence.

It is known that obstructive sleep apnea can contribute to cardiovascular diseases, and for bodybuilders who do not treat their sleep apnea, they could be at a higher risk of stroke, heart attack, cardiac arrhythmias and sudden death in sleep.

Obstructive sleep apnea is on a spectrum, so a patient with mild sleep apnea is at a lower risk of cardiovascular events than a patient with severe obstructive sleep apnea.

Does bulking up cause sleepiness, problems focusing and concentrating?

It can in some people. If your airway is narrower because you gained weight and air is not flowing as well as it did at a lighter weight, then you might be blocking your airway during sleep.

If you don’t sleep well, then you won’t get the proper rest that you need both from a mental and physical perspective.

Sleepiness is a big problem in obstructive sleep apnea patients.

In his blog post, Derek describes his own personal experience with bulking up to 250 lbs.  He found that as his weight increased, he found himself having a difficult time staying awake during classes, and even while driving.

How do you treat obstructive sleep apnea in bodybuilders?

The first line treatment of obstructive sleep apnea in adults is positive airway pressure therapy in most cases.

Usually, the larger the adult, the higher the positive airway pressure requirements. For example, if a bodybuilder is at competition weight (lean), they may require 10 centimeters of water pressure and then if the bodybuilder is heavy (offseason weight), they may require 15 centimeters of water pressure to hold the airway open.

If the patient has very large tonsils, then removal of the tonsils could be recommended as a first line treatment or to help lower the pressure on the machine.

Bodybuilder wearing CPAP mask. This is a full face mask. CamachoMD.com
Bodybuilder wearing CPAP mask. This is a full face mask.
Bodybuilder in offseason large and wearing CPAP mask. Note that the mask is a triangular shaped nasal mask. CamachoMD.com
Bodybuilder in offseason large and wearing CPAP mask. Note that the mask is a triangular shaped nasal mask.

Resources:

A google search for information on bodybuilding, snoring and OSA together will yield forums, blogs, discussions, and recommendations from sites such as Facebook, bodybuilding.com, reddit.com, youtube.com, sleepreviewmag.com, pinterest.com, united-muscle.com, elitefitness.com, muscletalk.com, professionalmuscle.com, sleepguide.com, and steroidology.com.

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Berry, R.B., et al., The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0.2. 2013, Darien, Illinois, USA: American Academy of Sleep Medicine.

2.            Kanagasabai, T., et al., Association between Sleep Habits and Metabolically Healthy Obesity in Adults: A Cross-Sectional Study. J Obes, 2017. 2017: p. 5272984.

3.            Agha, B. and A. Johal, Facial phenotype in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. J Sleep Res, 2017. 26(2): p. 122-131.